CHAPTER 13. THE PARAPHILIAS
The word paraphilia is from the Greek for love of what is beyond. A paraphilia involves the fixation on an unusual or partial object or act that impairs the capacity for affectionate sexual relations.
It is very difficult to get estimates on the occurrence of paraphilias. Many of these behaviors face extreme social condemnation, and, thus, tend to be underreported.
Probably in no field is there such moralistic revulsion again deviant acts as against the paraphilias. For instance, pedophilia is considered such a terrible crime, with good reason, that in the prison system the pedophiles are considered the lowest of the low and are subject to violent attacks by other prisoners. Revulsion, however, does not have to be moralistic. We can hate the act, while not hating the perpetrator for even in this most emotionally volatile area, biological disturbances are present. It is not these persons' moral failings, but biological failings that are at work.
Types of Paraphilias
Rosenham and Seligman (19 :376) divide the paraphilias into three categories. The first is where is sexual arousal and preference for nonhuman objects, including fetishes and transvestism. The second is sexual arousal and a preference for situations that involve suffering and humiliation, including sadism and masochism. And, lastly, there is sexual arousal and preference for nonconsenting partners, including exhibitionism, voyeurism, and child molestation. Money (1988) divides the paraphilias into six categories. Wee Table 1 at the back of this chapter.
Many people may have experienced feelings which have some surface relationship with the paraphilias. For instance, some people may be surprised at feelings of intense curiosity about the sexual adventures of a friend. The curious person may wonder if he/she suffers from the paraphilia of voyeurism. Occasional interest, however, does not constitute a paraphilia. The paraphilias are often quasi-obsessional and very ideational, often accompanied by relative hyposexuality. Also the paraphiliac is terribly focused on the very narrow object that forms only a small part of the sexuality of a non-paraphiliac. Other descriptive terms for paraphilias are overspecification and exclusivity. What is peripheral for the non-paraphiliac becomes central for the paraphiliac (Flor-Henry 1987:78).
We have already discussed the concept of love maps that result from some type of "imprinting like process." The love map contains a complete inventory of imagery and ideation. It has a story line that constitutes drama or fantasy, that facilitates and intensifies the achievement of arousal and orgasm.
The love map is an important concept in discussing the source of many conflicts between lovers. Often people fall in love because there is a personality fit between the two of them. In most cases, there has to be at least some sexual attraction between the couples. In the case of a lovemap that is paraphilic, however, the loved one often does not physically match the one described by the love map. Discrepancies can also arise between the physical love-making techniques between the two partners. In short, discrepancies can arise between the loved one and the love mapped one. For instance, a masochistic male may fall in love with a non-sadistic woman. Although love may exist between the couple, there may always be tension in the relationship because of the desire on the part of the male to be dominated sexually. The tension may increase if the paraphiliac requests that his partner dress in tight black leather and wear a wig in the bouffant style. The tension would escalate further if both partners had lovemaps that were at variance with one another.
The imprinting-like process involves the ordinary neural pathways of the human nervous system. Normally, daily experiences are sent along neural paths through the thalamus, and then are analyzed in specialized neocortical areas. The resulting refined data converge in the hippocampus, and, if not discarded, are eventually put into long-term memory. Events that occasion highly emotional responses are encoded more rapidly and lastingly in memory. When an event triggers an emotional response, stress-related hormones are released into the bloodstream. Under such conditions, sensory information is apparently sent in parallel not only to the hippocampus but also to the amygdala, which make an immediate connection with the memory structures. (Kushner 1988:169)
This normal circuitry has a remarkable plasticity in early childhood for the connections between neurons are not fully developed at birth. These connections increase dramatically in length and synaptic complexity during the first two years of life, continuing to develop at a more modest rate until approximately the twelfth year (Kushner 1988:166-167). Sensitive periods are critical time periods during which certain environmental cues may prime, orient, or specifically instruct behavioral development more so than at other times (D'Udine 1987:227). At some period of time these neural pathways sexually imprint on items in the environment.
A big problem is that no one knows how a lovemap develops into a paraphilic lovemap (Money 1988:133). It could be either prenatally or postnatally induced. Scientists think it is related to temporal lobe or limbic brain epileptic dysfunction. Support for this idea is the dissociative or fuguelike state (called the paraphilic "seizure") directly observed in some paraphiles. It may even be possible to record the seizure on a PET scan of the brain.
Subsequent research has pointed out that imprinting is not such a rigid process as originally depicted. Some imprinted behavior in some species is not always irreversible; under particular experiential conditions, an imprinted behavior can be modified by a process of re-imprinting (Clarke and Clarke 1976; Salzen and Meyer 1968). In addition, sensitive periods are not strictly fixed; they can undergo shifts in their occurrence and modifications in their temporal extent (Bateson 1978).
In erotic arousal, the left hemisphere inhibits and controls the sexual proclivities of the right hemisphere. In the case of paraphilias there are disturbances in the laterality of this brain organization (Flor-Henry 1987:58&61). Animal research (cited in Langevin 1990:104) points to the temporal lobes of the brain with their associated limbic structures as the producers of sexual arousal. Researchers have found that the removal of the temporal lobes of monkeys resulted in hypersexual and deviant sexual behavior. The monkeys became sexually aggressive in that they sexually approached larger animals that they usually feared. In addition, the monkeys attempted to mate even with animals of other species.
Temporal lobe epilepsy can cause impotence as well as a loss of libido. In other cases, however, there is an increase of libido and, for some, the appearance of anomalous sexual behavior, including bizarre behavior. Mitchell, Falconer, and Hill (1954, cited in Langevin 1990:104) reported a case in which an individual was attracted sexually to safety pins. Safety pins actually became a regular part of his masturbatory practices.
Paraphilias result from impairment of neural circuits (faulty wiring) laid down before birth and shortly afterwards, and are associated with other indications of minor brain damage occurring in infancy. An association of temporal lobe epilepsies with fetishism and transvestism in men was observed by Epstein (1961) and a similar connection with transsexualism has been reported by Hoening and Kenna (1979). There have been several clinical reports of compulsive sexual deviations that have been surgically removed (e.g. Mitchell, Falconer and Hill 1954). Research by a Czechoslovakian team (Kolarsky, Freund, Machek and Polak 1967) showed that a wide range of male deviations including homosexuality, sadomasochism and exhibitionism, as well as fetishism, were associated with minor damage to the temporal lobe, and what is most interesting, this damage only affected sexual preferences if it occurred before the age of three.
Reinforcement of a biological basis for paraphilias is the fact that so many of them occur together in the same person. Langevin (1983, 1985) has reviewed the empirical evidence that indicates that the presence of a sexual deviation increases the probability of occurrence of other sexual deviations in the affected individual: transvestism and fetishism; heterosexual pedophilia and exhibitionism; exhibitionism and voyeurism (with orgasm) and solitary outdoor masturbation; voyeurism and heterosexual pedophilia, obscene telephone calls, transvestism, and exhibitionism; sexual aggression and rape and heterosexual hebephilia (13- to 15-year old), exhibitionism, voyeurism, frottage and transvestism (orgasm); sadomasochism (majority "versatile": only 15 percent exclusively sadist or masochist = one-third heterosexual, one-third bisexual and one-third homosexual); sadism and exhibitionism, orgasmic cross-dressing, and feminine gender identity; pedophilia and exhibitionism, cross-dressing, voyeurism, frottage, and rape; and fetishism and transvestism.
Social-developmental input (in the form of sexual rehearsal play), also plays a role in the development of paraphilias. Unfortunately, in a puritanical society sexually interested children are often subjected to humiliation and abuse. This punishment can prove very counterproductive for it might actually increase the likelihood of the child developing a paraphilia. Punishment causes fear and the desire to flee and this induces the normal body reaction of adrenalin release. Adrenalin helps cement experiences in memory. This may in turn insure that the disapproved behavior becomes permanently fixed in the punished child's love map. In other words, punishment may prevent the normal fixation of lust into the development of the lovemap. An example is the punishment of a small boy for proudly exhibiting his erect penis to a group of girls (Money 1988:134-135). Severe punishment from the boy's parents risks searing exhibitionism into the lovemap of the boy.
There is a great deal of fear of the stranger who kidnaps the child from the street. Most acts of convicted pedophiles, however, take place between the child and a family acquaintance, neighbor, or relative. The acts usually occur in the child's own home or during a voluntary visit of the child to the home of the pedophile. There are different types of pedophiles (Langevin 1990:108). Some are heterosexual, while others may be homosexual or bisexual pedophiles who interact with minors of both sexes.
There are some interesting demographics on the pedophile. The convicted molester is typically older than those in any other class of sex offenders, with the average age being thirty-seven. The majority of those convicted are married. Despite their marital status, they are usually uneasy in adult social relations, not to mention sexual ones, being more comfortable with children than adults. Convicted pedophiles are highly Victorian (often feeling guilt-ridden) and rigid in their own sexual attitudes. They generally believe in the double standard and are often highly religious.
The demographics of pedophiles may be interesting, but are less important than biological relationships. The causes of pedophilia are being sought in left hemisphere problems. In particular, the anterior and temporal horns in the left hemisphere of the brain have been found to be dilatated on CT scans. This result occurred in 40 percent of the pedophiles but was not seen in the controls at all. This relationship has been supported by non-physiological tests. These are non-invasive tests designed to assess damage to certain areas of the brain. The H-R battery is the Halstead-Reitan Neuropsychological Test Battery. This test measures behavior associated with different brain sites. For example, the Categories Test is considered a "frontal lobe" task, since it has been used to identify brain injuries in the frontal cortex. The pedophiles showed clinically significant impairment of the H-R battery, which was consistent with the findings of the CT scan. Two of three pedophiles showed left-hemispheric pathology on either the CT or H-R battery or both (Langevin 1990:108-109).
Flor-Henry (1987:53) reports that in pedophiles there is evidence of problems in the asymmetrical organization of the hypothalamic/pituitary/endocrine systems. In pedophiles there is a significant increase in LH response to LHRH compared with nonpedophilic paraphiliacs and normal control men.
A special form of pedophilia involves incest (Williams and Finkelhor 1990:251-252). Incestuous fathers have a wide range of problems some of which are: difficulties in empathy, nurturance, and caretaking; social isolation and few social skills; while four-fifths were not sexually abused as children, there is usually some history of physical child abuse including parental maltreatment, particularly rejection by fathers; low sexual arousal to, or even disgust with, normal adult sexual partners; and weak masculine role identification.
In the early 1950s, Kinsey showed that one-quarter of the women in his study had been involved in a sexual encounter before age twelve. But only 6 percent reported a sexual experience with an adult male relative, and only 1 percent reported an incestuous relationship with a father or stepfather (Herman 1985:83). Kinsey's figures may have well been low. Preliminary data from interviews with a random sample of women in California (Russell 1983 in Herman 1985:83) indicate that 38 percent have had a childhood sexual contact with an adult, 16 percent with a relative, and 4.6 percent have been involved in father-daughter incest.
Male presence in the child's household did seem to provide greater opportunity for incest in cases where there was no mother present (Gordon and O'Keefe 1985:75). The absence of the mother might have other meanings than simply creation of opportunity. The absence or weakness of a mother may make a girl psychologically as well as physically more vulnerable to sexual assault. Many times the mother is also subject to abuse, especially violence. A total of 44 percent of the mothers in the sample were such victims. Other mothers were ill or had some disability, while still others suffered from alcoholism or an inability to speak English well. Many were in multiple categories.
The theme most commonly repeated, and which contradicts popular belief, is the apparent normality and conventional appearance of incestuous families. Incestuous fathers are often obsequious before authority figures such as doctors. Because they are exquisitely sensitive to the realities of power, they rarely attempt to intimidate any one who has equal or greater social status such as an adult professional. Rather, they will attempt to gain the professional's sympathy. Sometimes professionals are fooled by this performance. In most cases, the family structure represents a pathological exaggeration of generally accepted patriarchal norms (Herman 1985:84-85). Because paternal dominance is socially accepted, the abuse of paternal authority often goes unrecognized. Incestuous fathers are often well-respected in their communities. The fathers may often strive to maintain the public fiction that they are very competent fathers and husbands. Their wives are often completely dependent upon them for economic survival. Incestuous fathers often attempt to isolate their families, restricting both the mobility and social contacts of their wives and daughters. Often the women cannot even drive a car or visitors are prohibited.
Distress symptoms frequently displayed by incestuously abused children include insomnia, nightmares, bedwetting, fearfulness, social withdrawal or misbehavior, and somatic complaints, particularly lower abdominal or pelvic pain (Herman 1985:87-89). A few children may attempt to re-enact the sexual encounters with younger playmates. Although many victims can overcome these symptoms in adulthood, most studies indicate that incest victims suffer significant and persistent psychological impairment in adult life. For instance, a history of incestuous abuse appears to be linked to unusually high risk of repeated victimization in later life, including rape and battery.
Sadism came to be named for the Marquis de Sade (1740-1814), a French writer who described sadism. Sadists are usually men who receive sexual gratification from inflicting injuries on others. The sadist also may show interest in masochism and may engage in these behaviors himself. Sadists manifest gender disturbances, as measured by the Freund Gender Identity Scale (Langevin 1990:106-107). They show either gender indifference or feminine longings. Hyposexuality is often a problem with paraphiliacs. In sadists, retarded ejaculation, as well as impotence, are common.
Sadism may be a temporal lobe problem in that temporal lobe epilepsy is often associated with impotence (Langevin 1990:107). There is CAT-scan evidence of right temporal lobe abnormality in sadistic rapists. The sadists showed more overall impairment on the H-R battery than did nonsadistic sexual assaultists or controls. The Speech Perception and Trails Making subtests were significantly poorer in the sadists than in the other groups. Moreover, researchers have found that right temporal horn dilatation was significantly more common in sadists than in others (Langevin 1990:107-108).
The temporal damage in sadists may let older archaic sexual feeling arise that otherwise would be subdued. We have seen that according to McLean's triune theory there is an archaic reptilian complex still in the human brain. The archaic reptile stratum may play a significant role in human sadistic behavior (Eibl-Eibesfeldt 1987:158-159).
The archaic reptilian complex also plays a role in human aggression. Work by McLean (1973) is particularly interesting because he showed that stimulation of monkey's brains in the diencephalic area resulted in erection whereas stimulation a mere millimeter away resulted in the showing of fangs and aggressive behavior. This finding suggests a reason why sexual and aggressive behaviors are so commonly associated in lower animals, and, therefore, may also be associated in humans.
Masochism is sexual arousal produced from being injured or humiliated. Pain and mood are intimately interrelated because they are lateralized to the non-dominant side of the brain. In the imprinting process a disturbance, such as in temporal lobe epilepsy, could occur that results in masochism. The disturbance could result in the abnormal fusion of cerebral systems related to pain and orgasmic response (Flor-Henry 1987:60).
Social influences may also be important in the creation of this paraphilia. Severe punishment at critical times of imprinting could lead to masochism. The person being punished may have a brain predisposition for paraphilia and this combined with punishment may lead to an association between punishment as spanked buttocks on the one hand and sexual feelings on the other (Wilson 1987:110-111).
The exhibitionist becomes orgasmic only if imagining or displaying in front of an adult woman, who is both unaware and sexually neutral in behavior. Exhibitionists find scenes of fully clothed, erotically neutral females much more exciting than nude pictures (Langevin et al., 1979). (An interesting question is how would this phenomenon affect the definition of pornography as appealing to prurient interests?) Voyeurism, often associated with outdoor masturbation, is specifically linked to exhibitionism.
In studying male exhibitionism, research has found that exhibitionists primarily desire to frighten the subject (Eibl-Eibesfeldt 1987:161). Other motives include the desire to surprise or startle the onlooker; see admiration; and demonstrate superiority through displaying.
A higher proportion of exhibitionists are left-handed compared to the population. The excess of sinistrality in exhibitionist groups (20.5 percent) suggests the presence of left hemisphere dysfunction, which in turn means abnormal right frontal activation (Flor-Henry 1987:76). Consistent with this interpretation are the findings of EEG configurations that show excessive right frontal activation, reduced coherence, and slowing of frontal oscillations.
Treatment of Paraphilias
The medication used in the treatment of paraphilia is the synthetic hormone, medroxyprogesterone acetate (MPA), trade-named Depo-Provera (Money 1988:178). It is related in biochemical structure to both progesterone and testosterone, but its biological action resembles that of progesterone. It is an antiandrogen because it is competitive with testosterone in binding to receptor cells. The drug puts the testosterone-producing cells of the testicles temporarily at rest. This lowers the blood level of testosterone to that of prepuberty (but does not eliminate testosterone all together).
Table 1. Paraphilias and Their Definitions (Money 1988)
fetishism erotic token
hyphephilia tactile fetish
olfactophilia smell fetish
hybristophilia criminal or convict partner
somnophilia sleeping partner
chremastistophilia blackmail payment
autassassinophilia self-staged own death
erotophonophilia lust murder
masochism being injured, humiliated
raptophilia rape, biastophilia
sadism injuring, humiliating
symphorophilia disaster, conflagration
autagonistophilia live-show self-display
exhibitionism indecent exposure
frotteurism rubbing against a stranger
narratophilia erotic storytelling
peodeiktophilia penile exhibitionism
pictophilia erotic graphics or films
scoptophilia onlooker, mixophilia
telephonicophilia lewd phone calling
toucheurism touching a stranger
voyeurism illicit peeping
acrotomophilia amputee partner
adolescentilism impersonating an adolescent
autonepiophilia infantilism, wearing diapers
chronophilia age discrepancy
ephebophilia adolescent partner
formicophilia crawling things
gynemimetophilia female impersonator partner
infantilism impersonating a baby
morphophilia physique discrepancy
nepiophilia infant partner, diaper-aged
pedophilia juvenile partner
stigmatophilia tattoo, piercing
Not a paraphilia:
andromimetophilia male impersonator's partner
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